Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

OMB 0938-1016

CMS is seeking approval to reinstate the Information Collection Request (ICR) and to update our burden estimates to Forms A and B in preparation for the next round. CMS will publish a slightly modified version of Form A so that bidders will be better able to identify and understand the new requirement related to bid surety bonds (Section 1847(a)(1)(G) of the Act, added by section 522(a) of the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114-10) (MACRA). We have made changes to Form B to remove the expansion plan section and to include the bidding methodology proposed in CMS-1691-P (83 FR 34304).

The latest form for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program expires 2021-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10169 Form A: Application for DMEPOS Competitve Bidding Program Form and Instruction
Form CMS-10169 Bidding Form (Form B) Form and Instruction
Form CMS-10169 Application for DMEPOS Competitve Bidding Program (Form A) Form and Instruction
Form CMS-10169 Change of Ownership (CHOW) - Purchaser Form Form and Instruction
Form CMS-10169 Change of Ownership (CHOW) Contract Supplier Notification Form Form and Instruction
Form CMS-10169 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure Form and Instruction
Form CMS-10169 Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D) Form and Instruction
Form CMS-10169 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C) Form and Instruction
CMS-10169_Supporting_Statement_Part_A - final.docx Supporting Statement A
CMS-10169_Next_Round_Crosswalk_Form_B.pdf Supplementary Document
Form A: Application for DMEPOS Competitve Bidding Program Form and Instruction
Bidding Form (Form B) Form and Instruction
Application for DMEPOS Competitve Bidding Program (Form A) Form and Instruction
Change of Ownership (CHOW) - Purchaser Form Form and Instruction
Change of Ownership (CHOW) Contract Supplier Notification Form Form and Instruction
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure Form and Instruction
Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D) Form and Instruction
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C) Form and Instruction

All Historical Document Collections

201812-0938-004 Approved without change	Reinstatement with change of a previously approved collection	2018-12-06
201807-0938-009 Comment filed on proposed rule	Reinstatement with change of a previously approved collection	2018-07-26
201703-0938-014 Withdrawn and continue	Revision of a currently approved collection	2017-03-23
201701-0938-004 Improperly submitted and continue	Revision of a currently approved collection	2017-02-08
201508-0938-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-08-05
201411-0938-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2014-11-03
201407-0938-008 Approved without change	Revision of a currently approved collection	2014-07-08
201305-0938-005 Approved without change	Revision of a currently approved collection	2013-05-10
201207-0938-007 Approved without change	Revision of a currently approved collection	2012-07-31
201111-0938-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2011-11-02
201110-0938-009 Withdrawn and continue	No material or nonsubstantive change to a currently approved collection	2011-10-24
201006-0938-016 Approved without change	Revision of a currently approved collection	2010-06-30
201006-0938-010 Preapproved	No material or nonsubstantive change to a currently approved collection	2010-06-23
200906-0938-011 Approved without change	Revision of a currently approved collection	2009-06-22
200704-0938-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2007-04-25
200701-0938-012 Approved with change	New collection (Request for a new OMB Control Number)	2007-01-12

OMB Details

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C)

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-10169

Quarterly Report

Fillable Printable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.